Incidence and risk factors of infection in a single cohort of 110 adults with systemic lupus erythematosus

Abstract number: P1149

Jeong S.J., Choi H.K., Lee H.S., Chin B.S., Choi S.H., Han S.H., Kim M.S., Kim C.O., Choi J.Y., Song Y.G., Choe K.W., Kang M.W., Kim J.M.

Objectives: Systemic lupus erythematosus (SLE) is a chronic, usually life-long, potentially fatal autoimmune disease characterised by unpredictable exacerbations and remissions with variable clinical manifestations. Although there is a high probability for clinical involvement of other various organs in patients with SLE, infectious diseases have emerged as one of the leading causes of morbidity and mortality, accounting for 14–45% for SLE-related deaths.

A number of factors have been reported to increase risk of infection in SLE patients. While previously studies have focused on describing risk factors, data regarding predictors of infection at the time of SLE diagnosis or immediately before the infectious event is deficient. The aims of this study are to describe infectious complications and analyse their risk factors at the time of SLE diagnosis using a single cohort of 110 adults with SLE.

Methods: A retrospective review of 110 patients who met the American Rheumatism Association criteria for SLE from June 1991 to January 2000 was performed. The records were analysed to determine the risk factors for infection by comparing patients who had suffered at least one infectious episode (n = 32; 38%) with patients that had none(n = 38; 60%).

Results: The incidence of infection in 110 patients with SLE was 4.4/100 patient-year. Pneumonia constituted 33 percent (14 cases) of all infectious complications and the most frequently yielded pathogen was Streptococcus pneumoniae(20%, n = 3). According to univariate analysis, significant risk factors for infection were: high SLEDAI score, total accumulated dose of corticosteroids, follow-up duration, initial C3/C4/anti-dsDNA antibody/WBC count, frequent flares. Multivariate analyses retained SLEDAI score (geqslant R: gt-or-equal, slanted13, p = 0.01), C3 (<90 mg/dl, p = 0.01), positive anti-dsDNA antibodies(p < 0.01) at the time of SLE diagnosis as independent predictors for infection and frequent flares(p = 0.04), follow-up duration (geqslant R: gt-or-equal, slanted8 years, p = 0.023) as independent risk factors for infection.

Conclusion: In lupus patients, infections are most often caused by community acquired bacteria. SLEDAI score, C3 level, anti-dsDNA antibodies are independent predictive factors and disease flare rate, follow-up duration are independent risk factors of infection. On the basis of our findings, it seems mandatory to closely observe SLE patients with factors mentioned above.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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